Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy.
Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Thromb Res. 2020 Nov;195:16-20. doi: 10.1016/j.thromres.2020.06.046. Epub 2020 Jun 29.
Chronic heart failure (CHF) is characterized by higher rates of atrial fibrillation (AF) and endothelial dysfunction (ED). First line anticoagulant therapy in AF is represented by direct oral anticoagulants (DOACs); several patients, however, are still treated with vitamin-K inhibitors. The use of DOACs is associated in previous studies with an improved vascular function. We therefore sought to evaluate possible changes in endothelial function assessed by flow-mediated dilation (FMD) in patients with CHF and AF shifting from warfarin to DOACs.
Forty-three consecutive outpatients were enrolled in the study. FMD was assessed at baseline and after 4 months. Patients were compared according to AC therapy.
After the first measurement of FMD, 18 patients "switched" to DOACs because of poor compliance to warfarin therapy or time in therapeutic range, 19 patients continued to use DOACs, 6 warfarin. "Switched" patients to DOACs therapy showed an improved FMD (19.0 ± 6.6% vs 3.8 ± 1.3%, p < 0.0001); C-reactive protein (CRP) levels decreased in "switched" patients from 1.4 ± 0.5 to 1.0 ± 0.7 mg/dl (p < 0.05). FMD and CRP changes were not significant in patients who did not changed anticoagulant therapy. In switched patients, changes in CRP levels were proportional to FMD changes (r = -0.50, p < 0.05). Shifting from warfarin to DOACs was significantly correlated to improved FMD levels even at multivariable analysis (p < 0.05).
Switch from warfarin to DOACs in patents with CHF and AF was associated in an observational non randomized study with an improved endothelial function. Changes in FMD values were related to changes in CRP levels.
慢性心力衰竭（CHF）的特点是心房颤动（AF）和内皮功能障碍（ED）的发生率较高。AF 的一线抗凝治疗是直接口服抗凝剂（DOAC）；然而，仍有许多患者接受维生素 K 抑制剂治疗。先前的研究表明，DOAC 的使用与血管功能的改善有关。因此，我们试图评估从华法林转为 DOAC 治疗的 CHF 和 AF 患者的内皮功能（通过血流介导的扩张[FMD]评估）是否有变化。
连续纳入 43 名门诊患者进行研究。在基线和 4 个月时评估 FMD。根据 AC 治疗对患者进行比较。
在第一次 FMD 测量后，由于对华法林治疗的依从性差或治疗范围时间的原因，18 名患者“转为”DOAC 治疗，19 名患者继续使用 DOAC 治疗，6 名患者使用华法林。转为 DOAC 治疗的患者 FMD 改善（19.0±6.6% vs 3.8±1.3%，p<0.0001）；“转为”DOAC 治疗的患者 C 反应蛋白（CRP）水平从 1.4±0.5 降至 1.0±0.7 mg/dl（p<0.05）。未改变抗凝治疗的患者的 FMD 和 CRP 变化不显著。在“转为”患者中，CRP 水平的变化与 FMD 的变化成正比（r=-0.50，p<0.05）。即使在多变量分析中，从华法林转为 DOAC 与 FMD 水平的改善显著相关（p<0.05）。
在 CHF 和 AF 患者中，从华法林转为 DOAC 的观察性非随机研究与内皮功能的改善相关。FMD 值的变化与 CRP 水平的变化相关。
